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HomeMy WebLinkAbout3965DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.58 -1 -1 BOX 31 :6 r L 1 , moll i 03965 s PUTNAM COUNTY HEALTH DEPAR'IlOW DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYS/�[,T�JEM REPAIR V ! O ' A - J/ -3-9,v z--? � 7� S ` O HM I S NAME fog o � -4 PHONE SITE LOCATION l� ec" b 20 MAILING ADDRESS PERSON INTERVIEWED PCHD Complaint # Name & ationship (i.e, owner,tenant, etc.) DATE :7— z 7 TYPE FACILITY s` PROPOSED INS /fILER PHONE REGISTRATION # Proposal (include sketch lockting all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal fram licensed professional engineer or registered architect. Proposal approved Proposal Disapproved Inspector's Signature & Title Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate shaving: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywalls surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. _ I; as owner, or reported 'ayent of owner—agree'—to the above s:andtions:.:: .::. -:. =. ;...._. . SIGNATURE TITLE DATE .� aP16: WAbe (PCHD); YeUc w (Tkn BI); Pink LbR licsnt) BRUCE R. FOLEY Public Health Director DEPAR'TN EN'T OF HEALTH 1 Geneva Road, Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845)278 - 6648 November 7, 2002 Mary Lyons & James Hanson 149 Tanglewylde Rd. Lake Peekskill, NY 10537 Re:Addition - Lyons/Hanson, Tanglewylde Rd. No Increases in Number of Bedrooms ( ')Putnam Valley; TM##83.5 8 - 1- =1-. _ Dear Ms. Lyons & Mr. Hanson: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated November 6, 2002 addition is approved with the following conditions. 1. The total number of bedrooms must remain at two ,without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Vallev. If you have any. questions, please contact me at your convenience. Very truly yours, Michael Luke . Public Health Technician _ I Public Health Director .,LOR.ETTA . -MOLWARl• KN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278'- 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLYI STREE* �� \& �c TOWN`,_t�era Tt TX MAP## .S A-A NA 4E PHONEt S-S8 ft,% PCHD# A 414 2 -✓'.. MAILTING ADDRESS DESCRIPTION OF ADDITIONQ�en�,��oe,Q� or�eK��t� e O ( Fla o`�.e 1:,. �2co�,.. �►(e�o�.�or. '(�.��o tom. otrrv�.Acn Q r foor� oaM� NUMBER OF EXISTING BEDROOMS _PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) rb`'"°� F\) 1\, prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster; NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00. . 2. Sketches of existing floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) *Non - professional sketches are acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office Nvith any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom count of dwelling. OFFICE USE Comments Feb98 BFhouseguidelines BRUCE R. FOLEY Public Health " "DiseeFar'- DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services .(845) 278 - 6558 WIC (845)•278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 September 4, 2002 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: 149 Tanglewylde Road Residence Tax Map 83.58 -1 -1 Town of Putnam Valley Gentlemen: According to records maintained by the Town, the above noted dwelling IS xx ,IS`t10T in compliance with Town code and the total number of bedrooms on record is 2 This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORDXXXXXXXXX OTHER Deputy Z9V1IQ&R& q Inspector BFhouseguidelines \143 WASM SO CL C-\- �Ce-ex- Rav-.� (0'\a,)� AOZ�, i i, F i i, r i r, i i PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR { BEDROOM .COUNT ONLY; BEDROOMS Signature & Title Date i= 0� n 6' 6' Y c¢ i t2 � co o G, 4 f - 7 ,1 G J� :i Go s�. �\cz, - ,+�`��� �ir� `� `� \Z'^�^ ���V . .. .: _ .. y : . ..c ��*] . .. .. a ._ r -. .. : .. .. r.` '.�C. �_ . _ .. ^. .. � ..coil .�• n.... - . .� \O X� SO � Rcom \a \\ F c�- V4 C Ceer Qotc� fv la %� ae`ia. avN �Co�o�ec�• C�c @�� PUTNAM:000NTYHEALTH DEPARTMENT DIVISION OFIENVIRONMENTAL•HEALTH SERVICES-­ ...... PROPOSAL FOR SEWAGETREATMENT::SYSTEM REPAIR Internal Use Onl PERMIT #_ ❑ ❑ Repair Permit issued in last 5 years. ©•'''Not in Watershed 0 Lj Repair wlthirrBoyd s CornQ1'; W. Branch or Croton Falis Res:. ❑. Delegate R® pair.wlthin 200 ft. of a wateroourse.o- DEGm apped wetland ❑ Joint` Review SITE'L.00ATION' TOWN t1Aiw (, f`J( TM # -�. .. OWNER'S NAME .. _.... PHONE:V.:R. 'g ". ............... ...... MAKING ADDRESS f APPLICANT,: Name &: Relationship (i e ; owner tenant contractor) s. DATE"' :G :; FACILITY TYPE ,�: : tL a PCHD COMPLAINT #• -- a PROPOSED INSTALLER PHONE # ` ADDRESS 1 a r : ..v. z l . T ' Pr" osal (include aaeparateaketch locating the house; properly-lines; all adjacent wells within 200 feet of r ®pair and.the location of existing and proposed system) NOTE: The Department may , re uire submittal of proposal from licensed professional "depending on the nature and extent bf the repair. ; o 4./ F I, as owner,agree to the conditions stated 6n't6is form SIGNATURE fr r r ; , :; u.d� �:.; TITLE . r. ...[SATE i t,,-� owner ;`` " I, -the septic`installer, agree to comply with the conditions of ttiis permit for the septic system repair, SIGNATURE ?� "� i' TITLE,xSy' f• ,`' { v �•..�. +.�. �' DATE (installer) Proposal approved with the following conditions::..: . 1. Procurement of any Town Permit,-if applicable: 2 Submission.of as built repair sketch by the septic system installer within 30 days of the repair,. in duplicate showing: a. Owner's name, Site Street Naive, TOwn and .flax MaR"number. b. Location of Installed components tied to twofixed points: %. c. System description (e.g., 1250 gal. Concrefe`septie tank; etc:) d: Installers name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design'and there is no guarantee to the duration at which the completed SSTS repair will function. 5. - No completed work is to be backfilled until authori 6tion to do so has been obtained`froni the Department. INTERNAL USE ONLY Proposal Approved. Propos�I.Denied.. ❑ S 4, j v J. Inspector's Signature & Title" •1' -' `''f° `' �'d ". "i Date Expiration Date s [Repair proposal is in compliance with applicibW, ,6deis, Yes ❑ No..O' COPIES. Pr_wrl• n..,nn.• Ir ip ------------------- ( 1 AOL- % / 1 30 3-7 77 �f l fqi"V-,11& F-c,� ocai &uy Plumbing /I-Jrain Services In-' 3 Finch Lane Lake Peekskill, N.Y. 10537 Tel: 1845) D-26-2471 A% &���J � PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Internal Use U l��Repair J/ Repair Permit Issued in last 5 years epair within Boyd's Comers, W. Branch or Croton Falls Res. within 200 ft. of a watercourse or DEC - mapped wetland SITE LOCATION OWNER'S NAME MAILING ADDRESS APPLICANT TOWN , Tr % 01 EM REPAIR' PERMIT # 'Wt in Watershed G Delegated ❑ Joint Review ✓� TM #0 PHONE #ys�S/�� Name 11 Relationship (i.e., owner, tenant, contractorr)) ` DATE G 710 FACILITY TYPE 1 -& t"1 PCHD COMPLAINT # PROPOSED INSTALLER PHONE # 4 YS�60 W-3)r ADDRESS REGISTRATION /LICENSE # 3 l� Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the I, as owner,agre o the conditions stated on this form � ` SIGNATUR TITLE DATE (owner) - I, the sept comply with the conditions of this permit the septic system repair ` SIGNATURE'. TITLE lA DATE b U (installer) Proposal approved with the following_ conditions: , 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points C. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved lir Proposal Denied ❑ 1.,- 4). Q"z!!X- &g 1/1/9/02 pector's Signature & Title Dfite I Expiration Date is in compliance with applicable codes Yes ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 ,..:i: =r�^uc ,�-,n� �'� s�:es'. >,'�f rte•- ,::r,nr'a� " ^� �;' �� �� � �, dt` � ti`s'« ai c • - +� va _IMP 7- - 1(4Q J \ '�• •, l; GIB � '+1 :`� .;- -,�A�;�~`J�' ,�"ti, 'f..� "� '"� '� E>`� • ��`� •k'" \.-^c '1? 1 j. �� �Gh, •�. 2ti l•ps�c .. ��"^� - � .A � -�`•` d�`�a� �'Td �� j�',"f � `in ' Fh' cw'.�.�! 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Name and Title TYPE OF FACILITY: %_ „/u, ,A_ee Ov _ FINDINGS: D 1 2 --* a. vie- � l 1 �o e,/1 loaJeQ lai/ 72, vvj , , _ to t EAU r �. Sga•C leq,.t y TVra,v Me.� f- Gr;�y 73r, C.O".t.ef i TN4PFC'T0R, TFT Signature and Title RFPCIRT RFC'.F.TVFT) BY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: \ \ \ \ \ \ LOT NO. 224 \ \ LOT NO. 223 •, \. LOT NO. 222 \ \ \ LOT NO. 271 \ \ \ LOT NO. 219 \ l_OT NO. 220 \ \ \ ' \ \ , . nn l • � 'ACS i . ...ry,�. -C•, N21'ST` -�0� 207.48' J _... • 1 � 1 LOT NO. 256 .AKE PEEKSKILL SECTION C FILED MAP NO. 185 N co I CONCRETE R TAINING WALL 1 1 1 i 1 1 � 1 I ' r i i r r , ' 1 1 � r r � r r I 1 , I r � i r r I 1 I i 1 I I I 1 1 1 1 ' 1 1 ' 1 1 ' 1 I � t �I AREt = 2.29; ACRES I ' r 1 I I I I i � I I I. ' I ' I I 1 LOT NO. 255 LOT NO. ;54 ; LOT NO. 253 LOT NO. .2,52 i I r 1 1 1 I , r I i I I I ' I i t i ' Al % 1 I 1 JrQ SLATE I d' PATIO 55.1 I I CONCRETE I 1 �f012.. . ' ` '1 \0.1: �• }�7[7 -'% PAR0 I -+� / (A mu � 1 I 1 UTILITY `t0 STONE POLE I WALK I I 1 � 1 I I 1 1 I. to I Cyil ry m 0 0 m LOT NO. 251 LAKE PEEKSKILL SEC FILED MAP NO. 1 • ta.ah' I I:v I 1- • I, `• PROPANE TAM; 0 S'iaNl. I 1 ' STONE RETAINING I S20'28' 40"1j STONE :).RAGE ii AC.7 I I I 10.05' ...r- ...- ..-. r ...� CONCRETE RETAIMNC "- ° "•�^:'J -iG WALI. ___... _. =Ti83.50' ' L =193.31' TANGLEWYI.DE ROAD - -' w unuTY UTILITY POLE POLE MAC' OF SURVEY 7w" 4.0-r 51 1-57'50 1-07 PSO ppl^Aco 6) e.5 '.. 14 70G,-;rHER R/17R A 7 PVID-- ACCESS L;i .6(k ZA5eMeA17 De9CR/5,6,0• hV DEED UBEB 345, R.46C- Y09 ., ice 5w lb w CERTIFIED TO: yl, GGGi 7WE CWlGbvAL 1W0A,*UA,eM A'^ e ol (4 �rA AV 0 AA -lur-o -,4fqo- A­185-�- NOT 'smzvov- I­ .%d I. Sea. SURVEY OF PROPERTY 8 Ow"n fm fh;, ftant•.lion SURVEYED: -------- TO. Co. FOR bi7eRw1m4T 10W OF THE lzmes only BROUGHT TO DATE =,o 0,A.' Af0A1&Af_1,Vr4r10A1- AMP N-410J 4 P, BY 0,•WCAR 7U,9Veyv,9S :DUE .70 71olE L4c& All co,fifi..fi— he,.. •,, •.I;d 1. IN, L E V E R I C H JOHN SALVATORE ROMEO.-.-. map and .pl., Ilieveof ..4y if Wd ..p or be-, t6.,.P,.*d ..1 .1' the ­ SITUATE IN THE Or 0A'_S0V171Zr,9ZK I,e.j;s"""",' he. sig-ofur. pp..,. haeen. TOWN OF PUTNAM VALLEY 4 OF OR M / 1.41 .4 AtWrV,-,?ZY "If 1. h'.6y —fired 1h.1 IN. ­Vey PUTNAM COUNTY rNZ PREMISES SNOPVAI HceEOAI 49EIA10 JratiF • A ROR7-10,V OF L.07- 2$O, BLOCS 55 AS J7?4',0V 40 C.d. el P .. flu lo, Urn! S­y. d.pl.d tk SHOWN ON A MAP&AIT17"LeD "LAKE '5440 opo: by A. N•. Y.A Sf.f. Ancel•fi.. d PeEkSA' /L 5ZrCF10A1 0 AfAR o�14trD lAo, �w -4,7 _h , -AAm couArry CZZ'Rt-.,s POLE ropce -A o.426ACRe5 4. r AREA -At MAY—P— 1020 AS —^Vs1851l -_-L3r eo e.5 '.. 14 70G,-;rHER R/17R A 7 PVID-- ACCESS L;i .6(k ZA5eMeA17 De9CR/5,6,0• hV DEED UBEB 345, R.46C- Y09 ., ice 5w lb w _W_ 3 CERTIFIED TO: yl, GGGi 7WE CWlGbvAL 1W0A,*UA,eM A'^ e ol (4 �rA AV 0 AA -lur-o -,4fqo- A­185-�- NOT 'smzvov- I­ .%d I. Sea. SURVEY OF PROPERTY 8 Ow"n fm fh;, ftant•.lion SURVEYED: -------- TO. Co. FOR bi7eRw1m4T 10W OF THE lzmes only BROUGHT TO DATE =,o 0,A.' Af0A1&Af_1,Vr4r10A1- AMP N-410J 4 X BY 0,•WCAR 7U,9Veyv,9S :DUE .70 71olE L4c& All co,fifi..fi— he,.. •,, •.I;d 1. IN, L E V E R I C H JOHN SALVATORE ROMEO.-.-. map and .pl., Ilieveof ..4y if Wd ..p or be-, t6.,.P,.*d ..1 .1' the ­ SITUATE IN THE Or 0A'_S0V171Zr,9ZK I,e.j;s"""",' he. sig-ofur. pp..,. haeen. TOWN OF PUTNAM VALLEY OF OR M / 1.41 .4 AtWrV,-,?ZY "If 1. h'.6y —fired 1h.1 IN. ­Vey PUTNAM COUNTY ,01R.c,^r10A1 A44),l &eENC'cr 7ZReP 846MIE&I Me Wed 1. Ifh he .0,11.9 NEW YORK OTHER ,50RV--Y0,'?Z- C.d. el P .. flu lo, Urn! S­y. d.pl.d tk by A. N•. Y.A Sf.f. Ancel•fi.. d -A o.426ACRe5 4. r AREA ri -_-L3r eo (exce" ..Cqe "o e.) ENCROACHMENTS 011LOW GRAPIZ OF ANT N SURVEYED AS IN P099119510N _W_ 3 CERTIFIED TO: yl, GGGi �rA AV 0 AA I­ .%d I. Sea. SURVEY OF PROPERTY 8 Ow"n fm fh;, ftant•.lion SURVEYED: -------- TO. Co. FOR only BROUGHT TO DATE ..b..q-.t 11.4, Tifle Co. . 0­ KEVIN BROUGHT TO DATE--..--..--.— All co,fifi..fi— he,.. •,, •.I;d 1. IN, L E V E R I C H JOHN SALVATORE ROMEO.-.-. map and .pl., Ilieveof ..4y if Wd ..p or be-, t6.,.P,.*d ..1 .1' the ­ SITUATE IN THE I,e.j;s"""",' he. sig-ofur. pp..,. haeen. TOWN OF PUTNAM VALLEY I NORTHRIDGE ROAD "If 1. h'.6y —fired 1h.1 IN. ­Vey PUTNAM COUNTY PEEKSKILL. N. Y':.' Me Wed 1. Ifh he .0,11.9 NEW YORK C.d. el P .. flu lo, Urn! S­y. d.pl.d by A. N•. Y.A Sf.f. Ancel•fi.. d P. E. B L. S. NYS LIC. NO. 027646' Lend S.,.y—' SCALE: I Eo, (exce" ..Cqe "o e.) ENCROACHMENTS 011LOW GRAPIZ OF ANT N SURVEYED AS IN P099119510N _W_ 3